Homebound Service Volunteer Form

Homebound Service
Community Outreach
Monroe County Public Library
303 E. Kirkwood Ave.
Bloomington, IN 47408
(812) 349-3050 ext. 2058

First name: 
Last name: 
Age:  
Address: 
City:  Zip: 
Phone:   Work phone:
Email: 
Do you have your own vehicle? Yes  No
Do you have proof of insurance? Yes  No
How far in the county are you willing to drive to deliver to a library patron?
Do you have a preference for a male or female patron?  Male  Female No preference
Do you have any experience in libraries or related work?  Yes  No
What are your reading interests?
Would you have time to select and deliver materials at least once a month?  Yes  No
Can you volunteer for at least one year? Yes  No
Comments or additional information:

Background Check: (Please read carefully before submitting application.)

I, (please type your name), understand that
my check in this box authorizes Monroe County Public Library to conduct a background check in connection with this application.



COMMUNITY OUTREACH
www.mcpl.info/outreach
812-349-3050, ext. 2058